Measurement of concentrations of six metals in Indian traditional medicine preparations and Sindoor powders

Abstract Background: Ayurveda is one of the traditional medical practices that is originated from India where it is still widely practiced. This study is an attempt to determine the concentration of 6 selected metals, namely chromium, cobalt, nickel, arsenic, mercury, and lead in 19 samples of Ayurvedic herbal medicines and 7 Sindoor powders sent by physicians for analysis. Methods: In this study, ICP-MS as direct analysis of a 1 in 100 dilution of the tested materials was employed which gives an estimate of the solubility of the metal constituents of the materials tested in 0.5% nitric acid. Results: The highest individual metal values found per gram in the tested materials were: chromium 3.2 microgram/g, cobalt 3.1microgram/g, arsenic 2811 microgram/g, mercury 1320 microgram/g, and lead 8329 microgram/g. Assuming only a 1 g intake/day of any single material tested, lead content exceeded in 10/26 (38%) of the preparations above the ANSI 173 oral permitted daily limit (PDE). Likewise, mercury and arsenic contents exceeded the oral PDE in 6/26 (23%). Some of these folk medicines had high levels of more than one element in it. The lead content in 3 of the 7 Sindoor powders surpassed the guideline. However, the nickel content did not exceed the PDE in the 19 samples tested. Conclusions: Our data shows that, many of Ayurvedic medicine preparations tested still contain toxic amounts of arsenic, mercury, and lead. Sindoor powder which is traditionally and religiously used by many Indian women at their forehead also contains heavy metals like lead. All these materials can pose serious health risks to their user

Electrolytes assessed by point-of-care testing - Are the values comparable with results obtained from the central laboratory?

Background and Aims: When dealing with very sick patients, the speed and accuracy of tests to detect metabolic derangements is very important. We evaluated if there was agreement between whole blood electrolytes measured by a point-of-care device and serum electrolytes measured using indirect ion-selective electrodes. Materials and Methods: In this prospective study, electrolytes were analyzed in 44 paired samples drawn from critically ill patients. Whole blood electrolytes were analyzed using a point-of-care blood gas analyzer and serum electrolytes were analyzed in the central laboratory on samples transported through a rapid transit pneumatic system. Agreement was summarized by the mean difference with 95% limits of agreement (LOA) and Lin\u2032s concordance correlation (p c). Results: There was a significant difference in the mean (\ub1standard deviation) sodium value between whole blood and serum samples (135.8 \ub1 5.7 mmol/L vs. 139.9 \ub1 5.4 mmol/L, P < 0.001), with the agreement being modest (p c = 0.71; mean difference -4.0; 95% LOA -8.78 to 0.65). Although the agreement between whole blood and serum potassium was good (p c = 0.96), and the average difference small (-0.3; 95% LOA -0.72 to 0.13), individual differences were clinically significant, particularly at lower potassium values. For potassium values <3.0 mmol/L, the concordance was low (p c = 0.53) and the LOA was wide (1.0 to -0.13). The concordance for potassium was good (p c = 0.96) for values 653.0 (mean difference -0.2; 95% LOA -0.48 to 0.06). Conclusions: Clinicians should be aware of the difference between whole blood and serum electrolytes, particularly when urgent samples are tested at point of care and routine follow-up electrolytes are sent to the central laboratory. A correction factor needs to be determined at each center

Agreement between paired blood gas values in samples transported either by a pneumatic system or by human courier

Background: Rapid accurate assessment of metabolic derangements is crucial in the critically ill. We evaluated if arterial blood gas (ABG) samples transported through a pneumatic tube system (PTS) agreed with values transported by a human courier. Methods: In this prospective study of 50-paired ABG samples, the couriered reference ABG was compared with those transported by PTS. Agreement was summarised by the mean difference with 95% limits of agreement (LOA) and Lin's concordance correlation (pc). Results: The mean (+/- SD) time from sampling to analysis was 35.7 +/- 23.2 (courier) and 38.6 +/- 22.1 (PTS) minutes. Agreement was good between courier and PTS for pH, PaCO(2), bicarbonate, oxygen saturation and PaO(2) values (pc > 0.97). Although the mean difference in PaO(2) values between PTS and courier was small (-0.9 mm Hg) and the agreement was good, individual differences were clinically significant (95% LOA -40.8 to 39.0). For PaO(2) 160 mm Hg compared to manual courier. This suggested exaggerated oxygen movement between the blood sample and air in the PTS. Conclusions: In this study, analysis of samples transported through the PTS resulted in clinically unacceptable PaO(2) values. Delay in transport and analysis of ABG samples should be avoided and samples transported manually if they cannot be assessed on-site.7 page(s

Anomalous Activity Measurements of Creatine (Phospho) Kinase, CK-MB Isoenzyme in Indian Patients in the Diagnosis of Acute Coronary Syndrome

In the present study, the cause of suspected false-positive (anomalous) values for CK-MB activity, in Indian patients investigated for ACS. Total serum CK and CK-MB activity, serum Troponin I were measured and CK-MB as a percentage of the total CK activity (%CK-MB) calculated. CK-MB was also estimated using densitometry and CK-MB mass assay. Anomalous specimens were tested for the presence of CK isoenzymes. In 22 healthy subjects, 11 male and female, the %CK-MB ranged from 3.6 to 30.2. In 11 male patients, with proven ACS, the %CK-MB was from 4.0 to 17.5. The cut off for anomalous CK-MB activity values was set as >33.0%. In 35 patients with anomalies, total CK values ranged from 39 to 231 U/L, CK-MB from 30 to 161 U/L. Investigation of CK isoenzymes, showed 10 patients had a CK-BB band, 14 an intermediate band between CK-MM and CK-MB (macro-CK type 1), 7 had a cathodal band (macro-CK type 2), and 3 had a band intermediate between CK-MB and CK-BB. This later band does not seem to have been previously reported. Against the CK-MB mass assay, the activity assay showed no correlation, in 43 patients (19 M, 24 F), Pearson coefficient (R2) was 0.006. The CK-MB immunoinhibition assay is better described as measuring “non-CK-MM activity.” A %CK-MB activity >6% as a marker of ACS is not valid in our patient population. Laboratories should not use only CK-MB activity as a biochemical marker of ACS